- Leslie McKellar
- Natural Light is key to the philosophy of patient-centered hospital design
My first trip to a hospital came after I discovered my arm had a new right angle.
It was 1979. I was five years old. I'd dropped out of a tree and snapped the bones in my right forearm. I don't remember if I was in a lot of pain, but do remember asking my mother if I was going to die.
While the emergency room did a lot for my arm, it did little for my state of mind. The hospital smelled funny. It was gloomy and dingy and strange. I've since forgotten most of the details, but I do recall this: the buzzing of fluorescent lights and the feeling that I was in a place where bad things happened.
I wanted to get out. Soon.
It's a commonplace experience. We get sick, go to the hospital, dread our time there. Hospitals scare us. They're big and impersonal and boring. They force us to focus on things we'd rather ignore: illness, chaos, death.
Plus, they're expensive. Heart-bypass surgery, for instance, requires a long convalescence. The longer it takes, the more it costs.
When the Ashley River Tower, MUSC's new heart, vascular, and digestive disease hospital, opened on Feb. 4, it got a lot of attention from newspapers around the state, and justifiably so.
It's big — 641,000 square feet with 156 single-patient rooms, including 32 beds in a state-of-the-art intensive care unit. It's new — a team of local and international architects designed it to reflect the neighboring urban landscape, with elegant curves echoing Charleston's nautical history. And it has a whopping price tag — about $400 million, including all the equipment. It's the first of five proposed facilities.
What really got the attention of reporters and editors, though, was the role of visual art in the facility: MUSC amassed one of the largest collections of art by local and regional artists on permanent display — paintings, drawings, photographs, sculptures, pottery, and even traditional Lowcountry sweetgrass baskets — with the rationale that it will help sick people feel better faster.
More than 850 works were purchased with the help of Mark Sloan, director of the Halsey Institute of Contemporary Art. Organizers placed art on every floor, every patient room, and in every waiting area in the hospital believing they would reduce stress and facilitate healing.
It was a no-brainer news story.
Still, I had more questions than answers.
MUSC wanted to showcase the work of local and regional artists, build a facility unmistakably grounded in a distinct place, and support art by educating the public. And, of course, there was the feel-good, New Age-y mantra of artful healing. That all sounds terrific, but why?
I personally believe art helps people, especially sick people and their families. Perhaps, as doctors straightened my crooked arm with a plaster cast, some aesthetic beauty, natural light, and smart interior design would have made my first hospital trip less dreadful for my mother and me.
But hospitals are in the business of medicine, not art. Why spend the time and effort searching, buying, collecting, and presenting hundreds of works of art? Why go to great lengths to launch an intense fund-raising campaign that exclusively targeted private sources?
What's the whole story behind the Ashley River Tower?
It turns out that ART, as MUSC's new tower is called, is among a new breed of hospital popping up around the country. These structures have been shorn of the Bauhaus severity of postwar America, in which hospitals, like the one I went to in 1979, were pretty much big concrete boxes with some windows in the front more suitable for religious ascetics and Spartan warriors than people in need of medical care. Benefitting from 30 years of sociological research and architectural innovation, these new buildings are being conceived with the patient in mind — more natural light, more natural decor, and, importantly, more art in patient rooms, waiting areas, everywhere.
This is not just about the meeting of art and medicine. Research does indeed show patients benefit from exposure to nature and beauty during recovery. But there's another dimension here, and that is how art is being used in smart and sophisticated ways to help solve major economic and management problems that hospitals face in the 21st century — soaring health care costs, patient satisfaction, fiercer competition, staff retention, 76 million baby boomers.
As we enter into a new age of building design, hospitals are increasingly turning to art. The Ashley River Tower has far more than a nice collection that helps people; medical experts and building designers are hailing it as a new architectural standard of patient care and cutting-edge hospitality.
The Ashley River Tower's website (www.muschealth.com/ashleyrivertower) uses the word "hotel" at least five times: "a convenient hospital with a hotel-like atmosphere"; "stunning architecture and built-in comforts ... make the place seem more like a hotel than a hospital"; "inspired by the ambiance of a fine hotel, the hospitality tower"; "five-star hotel-quality amenities such as concierge services and valet parking"; and it offers "patients ... the highest quality of care in a setting that rivals the comfort and style of a fine hotel."
In an interview, Dr. Raymond Greenberg, the president of MUSC, said he was not entirely comfortable with the word "hospitality." Though its semantic cousin is indeed "hospital," it still connotes a sense that the new hospital is more of a business than an institution of healing.
But enhancing the hotel-like features of contemporary health care facilities is at the heart of the trend sweeping the world of hospital design, one that has reached cities like Cleveland, Toledo, New York City, San Francisco, Los Angeles, Greenville, Augusta, Savannah, and many more.
"This is an essential component of what is widely known as evidence-based design," says Peter Bardwell, president of the Academy of Architecture for Health. "[MUSC's new building] cites a number of key principles for successful outcomes in a health care setting."
In other words, a hospital that feels like a hotel makes people feel more comfortable. The decor, the lighting, the visual art, the general ambience. These put us at ease.
The tower was designed to provide an abundance of natural light and views of nature (i.e., the Ashley River and its surrounding marshscapes), thus creating, in Bardwell's words, "positive distractions ... that appeal to us at a very basic level of calmness and reassurance."
- Leslie McKellar
- At MUSCs $400-million Ashley River Tower, art is used to create a hotel-like atmosphere that in the long-run, designers say, will result in cheaper health care
Every room, including the huge conservatory at the entryway of the "hospitality tower," is awash in pleasant, non-glaring natural light. Greg Soyka of LS3P, the local architectural firm that collaborated with NBBJ, an international company with a pedigree in health care facility design, to create the Ashley River Tower, says you can't overestimate the value of natural light.
"Hospitals have a horrible reputation for being dreary places, because there's no connection to the outside world," Soyka says. "There is a huge movement by designers and architects to assert that healing comes from the mind, not technology. Natural light is central to that."
In the past, hospitals were designed with the caregivers in mind. Hallways were made of hard materials to easily roll wheelchairs and gurneys. Walls were bare and white to make them easy to clean. Now hospitals are being designed to be "patient-centered" or "patient-focused." Hallways are often carpeted and walls are chock full of art. With the predominance of a new patient-centered ideology, it's easy to see why hospitals have come to adopt the hotel model of design.
In fact, an entire industry has sprung up around the notion of patient-centered care with consultants who specialize in the purchase of "hospital art." Organizations like Planetree have worked with hospitals in Greenville, Chapel Hill, Charlotte, and Gainesville, Fla., many built in the 1970s, to meet patient-centered needs and establish, according to the nonprofit's website, "domestic aesthetics, art and warm home-like, non-institutional designs which value humans, not just technology."
Greenberg told me that patients at ART are referred to as "guests" who can order food from "room service" selected from prepared menus instead of being served predetermined meals at predetermined times. These are ways in which hospitals have figured out that the environment patients are recuperating in is as much a part of the experience as the diagnosis, treatment, and recovery. The trend, he says, is a move toward greater sensitivity to the needs of patients and their families.
More art means cheaper health care
It's easy to see why Greenberg would be uncomfortable with the word "hospitality." Getting people to understand something new is a difficult task. In this case, we have the historical convergence of architectural design, medicine, business, and art — not an easy rubric to comprehend.
More than likely Greenberg would rather steer public perception toward an image of a hospital that's a place of beauty, serenity, and healing than risk public misunderstanding with a discussion about emulating the hotel model of design.
Even so, the new tower represents a new era in the business of medicine, in which a hospital must achieve very real, very practical, and critically important economic objectives. According to Bardwell, evidence suggests Greenberg's strategy is on the right track to achieving a "favorable effect on the economics of health care delivery," which is design industry-speak for something far more simple.
Better design and more art means good business.
Hospitals, whether for- or nonprofit, are fundamentally businesses, and they face daunting financial challenges. Insurance is a nightmare. Many can't afford it (nearly one in six Americans simply go without health care coverage). The costs are getting higher (one federal study estimated by 2017 nearly 20 percent of gross domestic product will go to health care).
If hospitals don't meet the bottom line, "they die or are absorbed," Bardwell says. Among business criteria required of the modern-day hospital are improving competitiveness, patient satisfaction, staff retention, and, obviously, a robust revenue stream. Fortunately, the tower is poised to have "a predictable and favorable return on investment," Bardwell says.
Since the 1980s, medical researchers have compiled loads of data to demonstrate a strong correlation between a health care facility's atmosphere and the amount of time it takes to heal. If you have access to light, nature, and beauty (as in a bunch of high-quality works of art), you'll likely get better faster. A cramped room with a view of a brick wall will likely hinder recovery despite the knowledge, skill, and technology that went into your treatment and care.
So the formula goes something like this: The longer you're in the hospital, the more it's going to cost you. The less time spent there, the less it's going to cost. If a hospital can find ways to encourage patients to heal faster — by creating an environment warmed by beauty, comfort, and ease — the cost for the hospital, the insurer, and the patient is going to be less.
In short, better design and more art means cheaper health care.
"The notion of greater hospitality has swept the health care conversation big-time," says Scott Miller, an expert on hospital design for the American Institute of Architects. "Reducing length of stay is a win-win. It'll cost less and there's less of a chance of hospital-borne infection."
Then there are the familiar habits of the marketplace: If a customer is treated well by a business, it's likely that customer will recommend that business. It's what economists call improving your market share. With each recommendation comes more business, which itself begets even more business and hence more money to the bottom line.
So, by amassing a collection of art by local and regional artists, MUSC's new hospital is indeed supporting artists, educating the public, and helping ease the minds of patients and families. But it's important, and realistic, to remember what inexorably animates it all.
"You improve your place in the marketplace," Miller says. "Art on the walls brings a certain scale and caliber and makes people more comfortable. At the heart of it is an economic incentive to secure the market share and get people to come back."
Eight years in a cave
The art, the light, the natural, airy atmosphere — it's not just for patients. It's for the family members who are waiting nervously for news about their loved ones.
Think about it. Most patients are flat on their backs. They're injured, sedated, or worse, unconscious. Interacting with a work of art is not the first thing on their minds.
"The focus for everyone is the illness," says Angus Whyte, executive director of Art for Healing, a nonprofit organization that buys and places art in hospitals around the San Francisco Bay area. "Art takes the focus off the illness."
There's a clear psychological pattern, Whyte says. If someone is sick, the best thing for them is a natural setting. If that's not possible, the next best thing is a picture of a natural setting. Nudes are out. They remind people of being poked and prodded. Nature, though, does the trick.
"The art helps them heal," he says.
Everyone benefits from the presence of art, even the doctors and nurses who are too busy with the concerns of medicine to bother with putting art on the walls. They usually don't notice, Whyte says. It's the people who don't want to be in a hospital — patients and their families — who are most conscious of how dreary the place is.
But when he's able to place art in hospitals, the response from staff is immediate.
"Suddenly, they feel better. The entire atmosphere changes," Whyte says.
That's absolutely true, says Paris Wiggins.
She's a registered nurse in the intensive care unit of the Ashley River Tower who was formerly assigned to one of MUSC's old hospitals.
- ART is being used to help address many problems facing 21st-century hospitals
"I spent eight years in that cave," she says.
Dank and depressing, it had few windows, no art, little in the way of color and light. Whenever patients were required to stay for longer than usual periods of time, she tried to put them in a room with a view.
Between 50 and 70 percent of a hospital's budget can go to labor. At the same time, the median age of nurses is between 45 and 50. If a hospital is in a rural area, the labor pool is shallow. If a hospital is in an urban area, the nationwide shortage of nurses allows them to cherry-pick the best jobs. Given these factors, it's best for a hospital to find some way to retain its workforce, as MUSC has for Wiggins, reducing turnover and the cost of training.
In short, better design and more art also means happier employees and, by extension, happier patients and families.
When Wiggins talks about her new work environment at the Ashley River Tower, she buoyantly lists off the art she encounters daily. She's conscious of how it makes her feel, but she's equally aware of how it makes patients and their loved ones feel.
"When you see your loved one on a table with an IV stuck in his arm, that's extremely stressful," she says. "The art gives people something to focus on other than the dire situation.
"It provides some relief."